Abstract
The objective of this investigation was to verify the hypothesis that the presence of lower airway bacterial colonization (LABC) can be a stimulating factor of airway inflammation, more frequent exacerbation, and impact on pulmonary function, independent of current tobacco smoking in the stable phase of chronic obstructive pulmonary disease (COPD). A total of 46 ex-smokers with moderate to severe COPD, 19 healthy non-smokers, and 17 ex-smokers without COPD were included in this study. Their sputum specimens were collected at the first baseline visit and at the second visit after a follow-up of one year. The samples were analyzed for bacterial growth by culture, and the levels of interleukin (IL)-6, IL-8, and tumor necrosis factor alpha (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). The frequencies of exacerbations and pulmonary function were compared at visit 2. At visit 1, 37.0% (17/46) were found to have LABC with bacterial loads ≥106 CFU/ml in their sputum specimens. Haemophilus influenzae was the predominant pathogenic organism isolated. IL-8, IL-6, and TNF-α in these patients’ sputum were significantly higher than those without LABC (p < 0.05). It was the presence of LABC that contributed to the significantly elevated IL-8 and IL-6 at the 1-year period (p < 0.05). LABC was also associated with significantly increased frequencies of exacerbations and declined forced expiratory volume in 1 s (FEV1) (p < 0.05). LABC was documented in a subpopulation of stable COPD patients; it may be responsible for the deterioration of pulmonary function of COPD patients by promoting airway inflammation and/or increased frequency of exacerbations independently of tobacco smoking.
Similar content being viewed by others
References
The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of COPD: 2003. NHLBI/WHO (GOLD) Workshop Report, NIH publication (2003). United States Department of Health and Human Services
Adams SG, Melo J, Luther M et al (2000) Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest 117:1345–1352
Chung KF (2005) Inflammatory mediators in chronic obstructive pulmonary disease. Curr Drug Targets Inflamm Allergy 4:619–625
Lopez AD, Shibuya K, Rao C et al (2006) Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 27:397–412
Chung KF, Adcock IM (2008) Multifaceted mechanisms in COPD: inflammation, immunity, and tissue repair and destruction. Eur Respir J 31:1334–1356
Anthonisen NR, Connett JE, Murray RP (2002) Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med 166:675–679
Aaron SD, Angel JB, Lunau M et al (2001) Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163:349–355
Sethi S, Murphy TF (2001) Bacterial infection in chronic obstructive pulmonary disease in 2000: a state-of-the-art review. Clin Microbiol Rev 14:336–363
Barnes PJ (2004) Small airways in COPD. N Engl J Med 350:2635–2637
Banerjee D, Khair OA, Honeybourne D (2004) Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD. Eur Respir J 23:685–691
Patel IS, Seemungal TAR, Wilks M et al (2002) Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 57:759–764
Wilkinson TM, Patel IS, Wilks M et al (2003) Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 167:1090–1095
Soler N, Ewig S, Torres A et al (1999) Airway inflammation and bronchial microbial patterns in patients with stable chronic obstructive pulmonary disease. Eur Respir J 14:1015–1022
Monsó E, Rosell A, Bonet G et al (1999) Risk factors for lower airway bacterial colonization in chronic bronchitis. Eur Respir J 13:338–342
Sohy C, Pilette C, Niederman MS et al (2002) Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed? Eur Respir J 19:966–975
Prieto A, Reyes E, Bernstein ED et al (2001) Defective natural killer and phagocytic activities in chronic obstructive pulmonary disease are restored by glycophosphopeptical (Inmunoferón). Am J Repir Crit Care Med 163:1578–1583
Noguera A, Batle S, Miralles C et al (2001) Enhanced neutrophil response in chronic obstructive pulmonary disease. Thorax 56:432–437
Yamamoto C, Yoneda T, Yoshikawa M et al (1997) Airway inflammation in COPD assessed by sputum levels of interleukin-8. Chest 112:505–510
Sethi S, Maloney J, Grove L et al (2006) Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173:991–998
Barnes PJ (2009) The cytokine network in chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol 41:631–638
Wilkinson TM, Patel IS, Wilks M et al (2003) Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Repir Crit Care Med 167:1090–1095
Stockley RA, O’Brien C, Pye A et al (2000) Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 117:1638–1645
Fuke S, Betsuyaku T, Nasuhara Y et al (2004) Chemokines in bronchiolar epithelium in the development of chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol 31:405–412
Bhowmik A, Seemungal TAR, Sapsford RJ et al (2000) Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 55:114–120
Gompertz S, Bayley DL, Hill SL et al (2001) Relationship between airway inflammation and the frequency of exacerbations in patients with smoking related COPD. Thorax 56:36–41
Tumkaya M, Atis S, Ozge C et al (2007) Relationship between airway colonization, inflammation and exacerbation frequency in COPD. Respir Med 101:729–737
Acknowledgments
We thank the staff of the Clinical Microbiology Department of the Hospital for their technical assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, M., Li, Q., Zhang, XY. et al. Relevance of lower airway bacterial colonization, airway inflammation, and pulmonary function in the stable stage of chronic obstructive pulmonary disease. Eur J Clin Microbiol Infect Dis 29, 1487–1493 (2010). https://doi.org/10.1007/s10096-010-1027-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-010-1027-7